This 68-year-old man with a 7-year history of prostatic carcinomaProstatic carcinoma is a highly metastatic form of cancer. developed metastases to the bones of the pelvis and lumbar spine which produced significant pain and discomfortBack pain resulting from vertebral metastases of prostatic carcinoma is not uncommonly the presenting symptom which leads to the discovery of the carcinoma. Pain occurs late in the metastatic process and is an indicator of a poor outlook for a patient.. He was treated with androgen deprivation therapy to slow the growth of the tumor and decrease the size of the tumor metastases in order to help relieve his bone pain. The androgen deprivation therapy did reduce his pain; however, two months after starting the androgen deprivation therapy, the patient experienced an acute myocardial infarctionMyocardial infarction is necrosis of myocardial tissue which occurs as a result of a deprivation of blood supply, and thus oxygen, to the heart tissue. Blockage of blood supply to the myocardium is caused by occlusion of a coronary artery. and died suddenly.
At autopsy the patient's myocardial infarctionMyocardial infarction is necrosis of myocardial tissue which occurs as a result of a deprivation of blood supply, and thus oxygen, to the heart tissue. Blockage of blood supply to the myocardium is caused by occlusion of a coronary artery. was found to have resulted from the thrombotic occlusionAn occlusion is a blockage. of the proximal left anterior descending coronary artery. There was evidence of cancer in the peripheral region of the prostate glandMost commonly, prostatic carcinoma arises in the peripheral region of the gland. and there were metastases present in the pelvis and lumbar spine. The patient also had moderate testicular atrophy.
This photomicrograph of prostatic epithelium demonstrates an in situ immunohistochemical technique that is used to identify the DNA fragments characteristic of apoptotic nuclei. This technique, terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end-labeling (TUNEL) is used to identify apoptotic cells (arrows) in histology sections.
The diethylstilbesterol blocks the normal trophic hormone response that controls prostate growth. With loss of trophic influence the prostatic epithelial cells go through apoptosis and this results in atrophy of the gland. This would be an example of pathologic atrophy of a hormone-dependent tissue.
Apoptosis is the result of a gene program that leads to self-destruction of individual cells. The apoptotic cells shrink, there is condensation of the chromatin, formation of cytoplasmic blebs, and fragmentation of the cell to form apoptotic bodies. Apoptotic bodies are membrane-bound fragments of cytoplasmic organelles with or without fragments of chromatin. A hallmark of apoptosis distinguishing it from necrosis is the fact that there is no inflammation associated with apoptotic cell death as compared to other types of cell death (e.g., necrosis).
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